Legacy Health System plans to improve medication safety across the continuum of inpatient and outpatient care by developing a single, shared, updated and reconciled medication and allergy list for each patient in the health system. This project directly supports the organization's patient safety goals and will assist in our mission of improving the health status of the community. Over the two-year project period, the project team will develop and test an idealized process to capture and maintain a reconciled medication and allergy list that flows with the patient through their care at every point within the system. This will enable all members of the patient care team to know exactly what medications each patient is currently taking, which medications have been discontinued, and the patient's medication allergies. Once the processes have been tested and refined through a Failure Modes and Effects Analysis, physicians, nurses and pharmacy staff will be trained on how to implement the processes and correctly and consistently use existing system tools. A central component of this project will be the development of objective criteria to be used in the hospital inpatient and primary care or home health outpatient settings to trigger pharmacist review and/or involvement in taking the patient's medication history. Research from adverse drug event trigger analysis will be used to identify specific criteria and forcing functions built into the system's new processes. The project will determine the additional pharmacy resource needs related to implementation of this process. An important element to the success of the proposed research will be the involvement of patients and families through focus groups and surveys to determine the most effective way to both collect from and provide to the patient their reconciled medication and allergy list. A patient/family/public education campaign at all Legacy hospitals and clinics will underscore the importance of personal awareness and understanding of the medication list as well as set the expectation that each patient should receive an updated medication list following discharge and/or an outpatient visit.